Hakan Artas

Detection of Bladder Tumors With 3-Dimensional Sonography and Virtual Sonographic Cystoscopy

Bladder tumors are among the most common types of malignant neoplasms of the urinary tract. The purpose of this study was to evaluate the potential value of 3‐dimensional (3D) sonography and sonographic cystoscopy in detection of bladder tumors.

Isolated congenital absence of the pericardium.

Absence of the pericardium can vary from partial to complete absence. Patients with complete absence of the pericardium are either asymptomatic or have nonspecific chest pain, and no treatment is needed. Patients with partial absence of the pericardium are at risk for possible symptomatic herniation of the left atrial appendage or left ventricle, leading to fatal myocardial strangulation. Therefore, it is very important to differentiate partial from complete absence of the pericardium. A 7-year-old girl presented with isolated congenital absence of the pericardium, which generally has a good prognosis. It is a relatively asymptomatic anomaly that usually requires no treatment. Some cases involve complications that require operative treatment. Absence of the pericardium can be precisely defined by computed tomography and magnetic resonance imaging.

Bronchial atresia of the right lower lobe

Bronchial atresia (BA) is a rare congenital anomaly that is found incidentally in approximately 50% of cases. It predominantly affects young men and generally produces no symptoms. The other 50% of cases have pulmonary symptoms such as fever, cough, or shortness of breath due to recurrent pulmonary infection or overinflation of the involved lung parenchyma. The most common site is the left upper lobe, particularly of the apical-posterior segment. The right lower and middle lobes are affected in only 8% of cases. The radiographic features may be highly suggestive of the diagnosis. The mucus-filled bronchus is seen as a rounded, branching opacity emanating from the hilum and is surrounded by an area of increased hyper-translucency. We report an unusual presentation of BA in a 43-year-old woman with a history of recurrent pulmonary infection and dyspnea. The patient was found to have BA in all the basal segments of the lower lobe of the right lung.

Relationship Between Clinical Grade, Cerebral Blood Flow, and Electroencephalographic Alterations in Patients With Chronic Subdural Hemorrhage

ObjectiveTo analyze the correlation between clinical grading, brain blood flow, and electroencephalographic (EEG) changes in cases with chronic subdural hemorrhage (CSH). Material and MethodsThirteen patients with unilateral CSH, who were treated in our clinic were selected. The preoperative peak systolic flow rate, mean flow rate, end-diastolic flow rate, resistive index, and pulsatility index (PI) of both middle cerebral arteries (MCA) were recorded in all participants by transcranial Doppler. In addition, EEGs of all cases were evaluated. ResultsClassification of the hemorrhage as hypodense, isodense, and mixed type by computed tomography scanning was not correlated with the brain blood flow. In cases with clinical grade 2 hemorrhage, the flow rate of the ipsilateral MCA was decreased. On the other hand, the ipsilateral PI had increased in the same cases. The thickness of the hemorrhage was below 2 cm in all patients with a normal EEG. The PI value was high in patients with an abnormal EEG. ConclusionsThe blood flow rate of the MCA on the hemorrhagic side in cases with CSH is lower than that of the contralateral artery. However, this decrease does not have a linear correlation with the thickness of the hemorrhage or clinical grade. The increase in the ipsilateral PI is more significant than the decrease in the MCA blood flow rate in determining the clinical grade. This suggests that hemorrhage should have an impact that is adequate to activate compensatory mechanisms to observe changes in the EEG recordings.

Investigating a Correlation between the Results of Transcranial Doppler and the Level of Nerve Growth Factor in Cerebrospinal Fluid of Hydrocephalic Infants: Clinical Study

Objective: In this study, the correlation between the level of nerve growth factor (NGF) in cerebrospinal fluid (CSF) and transcranial Doppler (TCD) results has been investigated during preoperative and postoperative periods of hydrocephalic infants. Methods: In the study, 27 patients (11 males and 16 females, aged 0–6 months) with congenital hydrocephalus were studied. CSF levels were obtained from the patients preoperatively and on postoperative days 3 and 30, and TCD was applied. The level of NGF was investigated in CSF by the ELISA method. The pulsatility index (PI) and resistive index (RI) were examined in the right middle cerebral artery by TCD. Results: The mean NGF level (0.27 ± 0.48 ng/ml) on the 3rd (NGF3) postoperative day was observed to be higher than the preoperative mean NGF level (NGF0; 0.15 ± 0.16 ng/ml; p < 0.05). The mean NGF level on postoperative day 30 (NGF30; 0.13 ± 0.13 ng/ml) was lower than the mean NGF3 level (p < 0.05). While the mean PI value on postoperative day 30 (PI30; 1.06 ± 0.068) was observed to decrease compared to the preoperative PI (PI0; 1.26 ± 0.83) and the PI on postoperative day 3 (PI3; 1.09 ± 0.063), the mean PI3 value exhibited a drop compared to the PI0 value (p < 0.05). Whereas the mean RI value on postoperative day 30 (RI30; 0.63 ± 0.023) showed a decrease compared to both preoperative mean RI (RI0; 0.70 ± 0.025) and RI on postoperative day 3 (RI3; 0.65 ± 0.021), RI3 displayed a drop compared to RI0 (p < 0.05). Conclusion: In this study, no correlation was determined between preoperative and postoperative NGF levels and preoperative and postoperative RI and PI values obtained from TCD examination. However, a positive correlation was found between the following results: preoperative PI and preoperative RI (r = 0.848); PI on postoperative day 3 and RI on postoperative day 3 (r = 0.690), and PI on postoperative day 30 and RI on postoperative day 30 (r = 0.707).

Neonate with meroacrania: radiological findings and review of the literature.

Acrania is a developmental abnormality characterized by a partial or complete absence of calvaria with complete but abnormal development of brain tissue. Acrania is a relatively common malformation and affects about 1 in 1000 newborns. Meroacrania refers to absence of the cranium with the exception of the occipital bone. Brain stem and cerebellum develop normally, but cerebral parenchyma tissue is covered with a thin membrane and severely dysmorphic supratentorial brain is also seen. The other system findings are normal. Magnetic resonance imaging findings of one neonate with meroacrania have been reported in medical literature. Other radiographic and computed tomography findings have not yet been reported. We report a female neonate with meroacrania with discussion of etiology, pathogenesis, radiological findings, and differential diagnosis.

Bilateral symmetrical hypodensities in the thalamus in a child with severe hypernatraemia

Received: 17 August 2004 Revised: 6 September 2004 Accepted: 6 September 2004 Published online: 11 March 2005 Springer-Verlag 2005 A 4-month-old boy was admitted with diarrhoea, poor oral intake, vomiting, lethargy and convulsions. Serum electrolyte levels were: sodium 199 mEq/l, potassium 6.3 mEq/l, calcium 7.6 mg/dl, phosphorus 5.2 mg/dl, BUN 47 mg/dl and creatinine 1.1 mg/dl. Brain CT showed bilateral symmetrical hypodensities in the thalami (Fig. 1). He was treated for hypernatraemic dehydration with appropriate IV fluid and electrolyte therapy. His condition deteriorated and he died following cardiac arrest 10 h later.Hypernatraemia is a physiological disturbance defined as a concentration of 150 mmol/l or more of sodium in serum. Important aetiologies in children include gasPediatr Radiol (2005) 35: 449–450 DOI 10.1007/s00247-004-1366-6 CLINICAL IMAGE

A Rare Cause of Right-Sided Air Bubble on Chest Radiograph: Intrathoracic Gastric Volvulus Related to Morgagni Hernia

Morgagni hernia is a rare disorder in adulthood, and most of the cases are asymptomatic. Symptomatic cases are extremely rare and present with life-threatening complications. Early diagnosis and surgery are lifesaving. We hereby present an adult case of symptomatic Morgagni hernia. Diaphragmatic herniation of the stomach and mesenteroaxial rotation led to intrathoracic gastric volvulus in this case. A right-sided air bubble on a chest radiogram was the only finding leading to the suspicion of diaphragmatic hernia. Computed tomography in the diagnosis of diaphragmatic hernias is of great importance.

Median arcuate ligament syndrome during pancreaticoduodenectomy

Median arcuate ligament syndrome is caused by the compression of the celiac artery by a fibrous band called the median ligament, which originates from the crus of diaphragm. The prevalence of Median arcuate ligament syndrome has been reported as 10%-24% among patients; however, the etiology is unclear. The components of the clinical triad include a chronic post-prandial pain, epigastric murmur, and weight loss. Diagnosis is based on clinical and radiological findings. Median arcuate ligament syndrome has been reported in a small portion of patients undergoing pancreaticoduodenectomy. Most patients have been diagnosed prior to surgery.

An unusual case of hematemesis and epistaxis caused by a pheochromocytoma

Pheochromocytoma is a rare catecholamine-secreting neoplasm that is the cause of hypertension in <0.2% of patients with hypertension. We encountered an unusual case of pheochromocytoma involving hematemesis and epistaxis episodes with accompanying hypertensive attacks. Venous ectasia was detected in the esophagus. Abdominal magnetic resonance imaging revealed an adenoma in the left adrenal region. The present case illustrates that pheochromocytoma can mimic different clinical conditions.